Care Management is an integral part of clinical operations, engaging key stakeholders - including clinicians, patients, their families, and caregivers - in care delivery and coordination. Traditionally, providers have limited Care Management efforts to the inpatient setting, focused on managing acute care episodes. However, the Affordable Care Act is rapidly changing the healthcare landscape by driving value-based care delivery models aimed at improving outcomes and reducing costs to the overall population.
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To succeed in the post-reform marketplace and capture market share, providers will need to take increased responsibility for population risk management and care coordination across the entire care continuum, expanding their reach to pre- and post-acute care settings and evolving into consumer-centric entities.
To accomplish this, Care Management must become an engine for innovation and be at the forefront of the change to value-based care delivery while being flexible enough to support this revenue transition period. Value-based care transformation requires an innovative and revolutionary move toward prevention-focused, highly-coordinated, and easily accessible care across the continuum.
In our practice, we have seen many attempts to change Care Management - unfortunately not all of them equally successful. As with an orchestra, participating parties within a care network need to be properly aligned and engaged to support change. Change also involves many layers - executives, physicians, and managers as well as all other staff. For such a transformational project, program leads must have the ability to influence change and understand the cultural and behavioral barriers they will encounter.
Top management endorsement seems so obvious but the fact that the endorsement must be of a consistent and persistent nature, as transformation is not carried out overnight, is often under-appreciated as a true success factor.
Care Management must become an engine for innovation and be at the forefront of the change to value-based care delivery while being flexible enough to support this revenue transition period.
For sustainable success, we believe that value-based care transformation must focus on enhancing and building capabilities in four core Care Management “pillars”:
Governance: Good governance is central to the delivery of patient-centric care across settings and locations. Crucial to high performance are: transparent standards, clearly communicated information, incentives to motivate certain behaviors and actions, and accountability mechanisms to hold providers to desired outcomes.
People and processes: Care Management as a department is the hub, the critical focus point connecting many “spokes” within the care network. While it is an individually-managed group of roles and functions within the care network, it impacts and is impacted by others. Our comprehensive approach integrates all those areas contributing to Care Management into the future processes and vision.
Measurements: Outcomes are critical measures of performance indicating whether the health system is meeting its objectives, resources are being used appropriately, and if the relevant priorities are being addressed. We review performance measures currently in place and identify future measures to drive the visibility and transparency necessary for Care Management transformation.
Technology: Health information technology is foundationally important because it allows health care providers to better manage patient care via secure capturing, analyzing, and sharing of health information and coordinating tasks across the multi-disciplinary team. We assess the current state of technology and develop a technology enablement roadmap based on the collaboratively–targeted future business and clinical requirements of Care Management.
Given the high-level of technological and market uncertainty, we work with our clients to embrace the risks inherent with innovation because, in times of rapid and disruptive change, it is more risky to operate in a “business as usual” mode. What made an organization successful in the past will no longer enable success in the future.
One of the ways we help organizations manage these risks is through prototyping with frontline staff and operations managers – putting a minimally viable model into a live but controlled environment, to rapidly learn what works and what doesn’t work – quickly abandoning elements that do not work while applying lessons learned to subsequent initiatives. The organization can then constantly iterate and build on the successes and failures until their retained models become implemented solutions.
Our approach positions provider organizations for success by building broad stakeholder buy-in and designing roadmaps which acknowledge organization gaps and weaknesses in order to prototype solutions which can be effective today and adapt to future needs.
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